背景:药剂师诊所提供专业的药学服务,可以改善公共卫生结果。然而,中国的初级卫生保健人员在实施此类诊所时面临各种障碍和挑战。找出存在的问题,为药师诊所的实施提供建议,这项研究旨在评估知识,态度,以及初级医疗保健提供者中药剂师诊所的实践。
方法:基于知识-态度-实践(KAP)模型的横断面调查,在上海的社区卫生中心(CHC)和私立医院进行,中国五月,2023年。描述性分析和帕累托原理被用于多重回答问题。卡方检验,费希尔的精确检验,和二元逻辑回归模型被用来识别与知识相关的因素,态度,和药剂师诊所的做法。
结果:共有223名初级从业者参与了调查。我们的研究表明,他们中的大多数人知识有限(60.1%,n=134),但态度积极(82.9%,n=185)对药剂师诊所,只有17.0%(n=38)实施了这些措施。药剂师诊所的首要目标是提供全面的用药指导(31.5%,n=200),药物教育(26.3%,n=202)是主要服务,和特殊人群(24.5%,n=153)标识为关键接收者。Logistic回归分析显示,教育,年龄,职业,position,工作资历,和制度极大地影响了他们的观念。具有学士学位的从业者,例如,在用药指导(aOR:7.130,95CI:1.809-28.099,p值=0.005)和处方点评(aOR:4.675,95%CI:1.548-14.112,p值=0.006)中,患者更有可能认识到药剂师诊所的重要性.此外,从业者表达了积极的态度,但信心不足,只有33.3%(n=74)的人对实施有信心。男性从业者的信心水平超过女性从业者(p值=0.037),与私立医院的同行相比,社区卫生中心(CHC)的从业人员表现出更高的信心(p值=0.008)。联合医师-药剂师诊所(36.8%,n=82)通过与医疗机构合作(52.0%,n=116)成为首选模式。首选每日会议(38.5%,n=86),注册费和药房服务费均被认为适合付款(42.2%,n=94)。确定的主要挑战是门诊高工作量(30.9%,n=69)。
结论:尽管初级保健医生对药剂师诊所持积极态度,知识有限,低信心,高工作量导致其实施的稀缺性。具有不同社会人口特征的从业者,比如教育,年龄,和机构,对药剂师诊所表现出不同的看法和做法。
BACKGROUND: Pharmacist clinics offer professional pharmaceutical services that can improve public health outcomes. However, primary healthcare staff in China face various barriers and challenges in implementing such clinics. To identify existing problems and provide recommendations for the implementation of pharmacist clinics, this
study aims to assess the knowledge, attitudes, and practices of pharmacist clinics among primary healthcare providers.
METHODS: A cross-sectional survey based on the Knowledge-Attitude-Practice (KAP) model, was conducted in community health centers (CHCs) and private hospitals in Shanghai, China in May, 2023. Descriptive analytics and the Pareto principle were used to multiple-answer questions. Chi-square test, Fisher\'s exact test, and binary logistic regression models were employed to identify factors associated with the knowledge, attitudes, and practices of pharmacist clinics.
RESULTS: A total of 223 primary practitioners participated in the survey. Our
study revealed that most of them had limited knowledge (60.1%, n = 134) but a positive attitude (82.9%, n = 185) towards pharmacist clinics, with only 17.0% (n = 38) having implemented them. The primary goal of pharmacist clinics was to provide comprehensive medication guidance (31.5%, n = 200), with medication education (26.3%, n = 202) being the primary service, and special populations (24.5%, n = 153) identified as key recipients. Logistic regression analysis revealed that education, age, occupation, position, work seniority, and institution significantly influenced their perceptions. Practitioners with bachelor\'s degrees, for instance, were more likely than those with less education to recognize the importance of pharmacist clinics in medication guidance (aOR: 7.130, 95%CI: 1.809-28.099, p-value = 0.005) and prescription reviews (aOR: 4.675, 95% CI: 1.548-14.112, p-value = 0.006). Additionally, practitioners expressed positive attitudes but low confidence, with only 33.3% (n = 74) feeling confident in implementation. The confidence levels of male practitioners surpassed those of female practitioners (p-value = 0.037), and practitioners from community health centers (CHCs) exhibited higher confidence compared to their counterparts in private hospitals (p-value = 0.008). Joint physician-pharmacist clinics (36.8%, n = 82) through collaboration with medical institutions (52.0%, n = 116) emerged as the favored modality. Daily sessions were preferred (38.5%, n = 86), and both registration and pharmacy service fees were considered appropriate for payment (42.2%, n = 94). The primary challenge identified was high outpatient workload (30.9%, n = 69).
CONCLUSIONS: Although primary healthcare practitioners held positive attitudes towards pharmacist clinics, limited knowledge, low confidence, and high workload contributed to the scarcity of their implementation. Practitioners with diverse sociodemographic characteristics, such as education, age, and institution, showed varying perceptions and practices regarding pharmacist clinics.